August 06, 2014

Is the Middle East ready to fight off an Ebola attack?

Given Africa’s size, diversity, fragile healthcare systems, resource shortage and frequently poorly educated population, extinguishing the ongoing outbreak at its roots will most likely take months.

The current outbreak is already moving faster than our efforts to control it, declared Margaret Chan, the Director-General of the WHO after a crisis meeting held last week in Guinea's capital of Conakry.

“If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries,” she stressed.

While most developed countries began tightening health measures at their portals of entry, the response from the Middle East is still fairly slow.

Emirates Airlines suspended its flights to Conakry, the Lebanese government suspended the issue of work permits and the Saudi ministry of health suspended issuing Hajj and Umrah visas to residents of the three badly hit African countries. Apart from these moves, no other precautionary measures were announced.

Granted, the chance of a sick person boarding a flight is very slim, but not zero. Ebola is a disease with an incubation period that ranges from two days to three weeks. The air export scenario is highly plausible with a patient who is incubating the virus and not showing any symptoms. Therefore, screening of passengers arriving from affected countries is imperative.

If an infected patient was unknowingly transported by air, crew members should be trained to spot the disease and deal with the patient in a way that reduces the chance of transmission to other passengers. Upon arrival, the patient should be temporarily quarantined at the airport and quickly transported to a hospital equipped with isolation units. All other potentially exposed passengers should be tracked down and monitored for three weeks to make sure that they don’t show any signs of illness.

Being on the frontline, healthcare workers are the most vulnerable to infection, and therefore must be educated about Ebola symptoms and proper protocol in handling infected patients. Treating Ebola patients relies on supportive care and rehydration, and if started early enough, it could significantly boost recovery rates.

Doctors treating Ebola don head to toe protective gear, but even with this, they are still at risk. On July 29th, Sierra Leone witnessed the sad loss of Sheik Humarr Khan, who treated more than 100 Ebola patients and died shortly after he contracted the disease from one of his patients.

Hospitals with appropriate hygienic measures and isolation facilities will definitely break the disease transmission chain and reduce the grave consequences of any outbreak. The Middle East needs robust healthcare facilities that can treat patients without fear of spreading the disease further.

Diagnostic tools are also important, since early Ebola symptoms are quite generic. Without proper serological and molecular tools, Ebola confirmatory diagnosis is challenging, and shipping samples to be tested abroad is a logistical nightmare.

Finally, certain rituals of handling Ebola victims will have to be practiced with extreme caution. For instance, burial ceremonies for Muslims usually involve washing the body of the deceased by family members. Ebola virus can survive for a long time in the body of the dead patient. In the unfortunate circumstances of burying an Ebola victim, the corpse must be properly disinfected and people handling it must wear strong protective clothing and gloves.

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Given Africa’s size, diversity, fragile healthcare systems, resource shortage and frequently poorly educated population, extinguishing the ongoing outbreak at its roots will most likely take months.

The current outbreak is already moving faster than our efforts to control it, declared Margaret Chan, the Director-General of the WHO after a crisis meeting held last week in Guinea's capital of Conakry.

“If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries,” she stressed.

While most developed countries began tightening health measures at their portals of entry, the response from the Middle East is still fairly slow.

Emirates Airlines suspended its flights to Conakry, the Lebanese government suspended the issue of work permits and the Saudi ministry of health suspended issuing Hajj and Umrah visas to residents of the three badly hit African countries. Apart from these moves, no other precautionary measures were announced.

Granted, the chance of a sick person boarding a flight is very slim, but not zero. Ebola is a disease with an incubation period that ranges from two days to three weeks. The air export scenario is highly plausible with a patient who is incubating the virus and not showing any symptoms. Therefore, screening of passengers arriving from affected countries is imperative.

If an infected patient was unknowingly transported by air, crew members should be trained to spot the disease and deal with the patient in a way that reduces the chance of transmission to other passengers. Upon arrival, the patient should be temporarily quarantined at the airport and quickly transported to a hospital equipped with isolation units. All other potentially exposed passengers should be tracked down and monitored for three weeks to make sure that they don’t show any signs of illness.

Being on the frontline, healthcare workers are the most vulnerable to infection, and therefore must be educated about Ebola symptoms and proper protocol in handling infected patients. Treating Ebola patients relies on supportive care and rehydration, and if started early enough, it could significantly boost recovery rates.

Doctors treating Ebola don head to toe protective gear, but even with this, they are still at risk. On July 29th, Sierra Leone witnessed the sad loss of Sheik Humarr Khan, who treated more than 100 Ebola patients and died shortly after he contracted the disease from one of his patients.

Hospitals with appropriate hygienic measures and isolation facilities will definitely break the disease transmission chain and reduce the grave consequences of any outbreak. The Middle East needs robust healthcare facilities that can treat patients without fear of spreading the disease further.

Diagnostic tools are also important, since early Ebola symptoms are quite generic. Without proper serological and molecular tools, Ebola confirmatory diagnosis is challenging, and shipping samples to be tested abroad is a logistical nightmare.

Finally, certain rituals of handling Ebola victims will have to be practiced with extreme caution. For instance, burial ceremonies for Muslims usually involve washing the body of the deceased by family members. Ebola virus can survive for a long time in the body of the dead patient. In the unfortunate circumstances of burying an Ebola victim, the corpse must be properly disinfected and people handling it must wear strong protective clothing and gloves.